Comprehensive Assessment Diagnosis and Treatment Planning of Severe Periodontal Disease

International Journal of Science and Research (IJSR)
ISSN: 2319-7064
ResearchGate Impact Factor (2018): 0.28 | SJIF (2018): 7.426
Comprehensive Assessment, Diagnosis and

Treatment Planning of Severe Periodontal Disease:
A Clinical Case Report
Dr Shabana Lone, Dr Jacob Thomas
Abstract: This paper attempts to describe the clinical and radiographic diagnostic features and the current treatment options along
with a suggested protocol for comprehensive management of severe periodontal disease with case report and a brief review. In this
report, periodontal treatment of a 56-year-old female patient with generalized severe chronic periodontitis is presented. Thelong-term
success of the treatment of the complex cases with severe chronic periodontitis depends significantly upon the proper control of the
periodontal infection and the achievement of a stable periodontal status. In this case apart from non-surgical approach, a surgical
approach is necessary for the treatment plan for regenerating the lost periodontal tissues as there is advanced attachment loss.
Keywords: severe periodontitis, hopeless teeth, alveolar bone loss, attachment loss
1. Introduction
Social history
Periodontitis is a disease characterized by progressive
destruction of the periodontium which is caused by  She works long hours and admits to having very stressful
relatively small group of microorganisms inhabiting the periods of work activity
subgingival biofilm (1). The goal of the treatment is to create  The patient is a heavy smoker for about 10 years and
proper oral environment which hampers the further would smoke about 6 to 8 cigarettes per day.
colonization of periodontal pathogens. The consensus  She likes sweets and ice creams and takes tea with sugar
opinion is that the mechanical cleaning of the root surfaces and milk 5 – 6 times a day.
(scaling and root planning) combined with meticulous oral
hygiene is the proper treatment of the periodontitis. Dental hygiene and oral care
(2)
However, in advanced cases the progression of the disease
could lead to different problems including gingival  She likes sweets and ice creams.
recessions, insufficiency of attached gingiva, tooth mobility  Patient has vigorous brushing techniques.
and tooth loss which require complex treatment. (3,4)
2. Examination & Records
History of presenting complaints
2.1 Extra-oral
A 56 year old female came with the chief complaint of pain
and mobility in the lower front teeth which started two TMJ examination TMJ – Even opening with no clicks
months ago. She reports a loose tooth, bad breath, and Full and wide range of jaw movements
bleeding gingivae since long time. Her last visit was several No other skin swellings
years ago. She also complains that eating has become more No facial asymmetry
difficult or uncomfortable. The pain was dull in character, No deviation of the mandible on opening and closing
and intermittent. The patient informed that years before she No extra-oral lesions on face neck or lips
used to have gingival bleeding when brushing or eating. She No lymphadenopathy
feels now her teeth have become loose and it is worsening No tenderness to palpation around TMJ
day by day. She would prefer to have them extracted rather No discomfort from the muscles of mastication
than continuing with existing state. Usually painless but The patient has a low to average smile line at her widest
occasionally pain is present and also sensitive to cold, heat smile.
or both in some of her upper teeth.
2.2 Intra oral
Previous medical history
Swellings or gland enlargement: - Salivary function – good.
 No significant past medical history. Able to elicit saliva from both parotid and both
submandibular ducts
Previous dental history Saliva of good quantity and quality.
 Previous visit to dentist were only for relief of pain. Pocket Charting
 Patient has an improper and vigorous brushing technique.
 No dental phobia or anxiety. BPE score:
*4 4 4*
*4 4 4*
Volume 9 Issue 3, March 2020

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Paper ID: SR20304125420 DOI: 10.21275/SR20304125420 272
ISSN: 2319-7064
Teeth present Occlusion
Missing teeth:-18,24,28,38,46,48 Class I skeletal base with class I canine relationship. Missing
Unerupted teeth: None lower right 1st molars and upper left fist premolar Anterior
Existing restorations: None edge to edge relationship and cross bite 12 and 42
Existing prostheses: None Supraerupted:-21, 16, 26
Mobility: in almost all the teeth
Tooth surface loss/tooth wear: abrasion 13, 14,15,16,17, 23, Tooth 12 is tilted palatally out of the arch
24,25,26,27. Lateral excursions –In group function.
Which is more severe in the upper dentition. Dento alveolar compensation 32 to 42
Secondary occlusal trauma.

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Paper ID: SR20304125420 DOI: 10.21275/SR20304125420 273
ISSN: 2319-7064
The key findings from the periodontal charting were:
 Pockets of 6mm and over in most of the teeth

 Furcation involvement in 16,26,2,36,37,47
 Recession is generalized
 The plaque score was high at 64%, ‐most plaque was on
the lingual surfaces of lower anterior region
 The bleeding score was 30%, with most bleeding areas
located at interproximal sites.
 Pathological mobility was found in almost all the teeth.
Abrasion: biomechanical frictional processes.
These lesions are provoked by tooth brushing.
Patient’s smile
Right Buccal view
Anterior View teeth in occlusion
Left buccal view
Anterior View teeth apart
Maxillary occlusal view

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Paper ID: SR20304125420 DOI: 10.21275/SR20304125420 274
ISSN: 2319-7064
13:- No existing restoration and no caries detected 20%
HBL, maximum probing depth 4, grade 2 mobility-guarded
prognosis
12:- No existing restoration and no caries detected
75%HBL, maximum probing depth5, grade 3 mobility- poor
prognosis
HBL, maximum probing depth5, grade 3 mobility- poor
prognosis
50%HBL, overerupted and interferes with occlusion
maximum probing depth 5, grade 3 mobility- poor prognosis
Mandibular occlusal view 50%HBL, overerupted, maximum probing depth 5, grade 2
mobility- guarded prognosis
Sensibility tests: - sensibility test with ethyl chloride was 23:- No existing restoration and no caries detected
done 60%HBL, overerupted, maximum probing depth 5, grade 2
mobility- guarded prognosis
These were undertaken for all affected teeth i.e.: 13, 25:- No existing restoration and no caries detected 30%
14,15,16,17, 23, 24,25,26,27 All of these teeth provided a HBL, maximum probing depth4, grade 1 mobility- good
delayed but positive response. Loss of vitality is often seen prognosis
amongst teeth which display signs of severe wear. It is 26:- No existing restoration and no caries detected
important to establish the health status of the dental pulp FURCATION 50% HBL, maximum probing depth5,
prior to embarking upon any complex prosthodontic mobility grade 2- guarded prognosis
rehabilitation. 27:- No existing restoration and distal caries, FURCATION
50% HBL, maximum probing depth 4- , grade 2 mobility –
Radiograph poor prognosis
Mandibular Arch

HBL maximum probing depth 9, grade 3 mobility- poor
prognosis
prognosis
prognosis
Generalized chronic periodontitis in a 55-year-old HBL maximum probing depth 5, grade 2 mobility- poor
female. There is generalized recession, plaque, calculus. prognosis
The radiograph shows generalized advanced bone loss
which is mostly horizontal. Furcation involvement in all 35:- No existing restoration and no caries detected 15%
the molars except 17. HBL, maximum probing depth 5, grade 2 mobility- guarded
prognosis
Full arch Analysis 36:- Furcation involvement 25% HBL, maximum probing
depth 4, grade 1 mobility- guarded prognosis
Maxillary arch: 37%:-No existing restoration and no caries detected,
furcation involvement 30%HBL, maximum probing depth
Maximum probing depth- 7. Grade 3 mobility.60% HBL –
HBL, maximum probing depth -9, grade 3 mobility- poor
Poor Prognosis
prognosis
supraeruption, furcation involvement, Grade 2 mobility.
HBL, maximum probing depth- 8, grade 3 mobility- poor
60% HBL- poor prognosis
prognosis
15:- No existing restoration and no caries detected maximum
probing depth- 5, 20%HBL, grade 2 mobility- guarded
60%HBL, maximum probing depth- 4, grade 3 mobility-
prognosis
poor prognosis
14:- No existing restoration and no caries detected maximum
probing depth 3, 20% HBL, grade 2 mobility-fair prognosis
25%HBL, maximum probing depth-3, grade 2 mobility- fair
prognosis

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Paper ID: SR20304125420 DOI: 10.21275/SR20304125420 275
ISSN: 2319-7064
45:- No existing restoration and no caries detected Patient discussion
30%HBL, maximum probing depth 4, grade 2 mobility- fair
prognosis The disease process was explained to the patient in detail,
47:- No existing restoration and no caries detected Furcation but at a level that was suitable (5). The importance of risk
involvement. 40% VBL, maximum probing depth 8, factors like smoking, stress was explained and about the
mobility grade 2- poor prognosis importance of oral hygiene. The causes of periodontal
disease were discussed, and the patient was warned
3. Diagnosis regarding the risks should periodontal disease progress
(further loss of attachment, tooth mobility and ultimately
Type IV (severe) Periodontal Disease (ADA code 4800) tooth loss). The importance regarding the harmful effects of
improper brushing techniques were explained to the patient.
Based on the patient‟s symptoms, clinically and Patient was also made understand that their role in managing
radiographically: - Generalized chronic severe periodontitis their periodontitis is fundamental to the success of treatment.
in a 55-year-old female. The radiograph shows generalized It was made very clear to the patient that unless this first
advanced bone loss which is mostly horizontal. stage of treatment was successful and that she responds well
to treatment, more advanced periodontal and restorative
The diagnosis was described as chronic as loss of attachment treatment options would be unsuccessful If patients can
has occurred gradually over a period of time, Severe- as experience improvements in their gingival health as a result
5mm or greater of attachment loss and generalized as more of their own actions, this can be a very powerful symbol
than 30% of sites were affected. Major loss of alveolar bone which will help them develop self-efficacy (6) Patient was
support usually accompanied by an increase in tooth also advised to consult a periodontist for further treatment.
mobility with possible furcation involvement. Probing depth
are generalized 6mm and above. Concrete plans were made with patients for how they will
manage their condition, particularly in respect to plaque
Tooth Surface Loss. control. We need to establish a time of day when it will be
Secondary occlusal trauma. convenient for the patient to spend the required time
Dento alveolar compensation 32 to 42 performing oral hygiene techniques. It doesn‟t necessarily
need to be just before bed, but ideally it should be at the
Local risk factors same time every day, so that it becomes a routine.
Smoking: - The most important known risk factor for this Risk factors
case is cigarette smoking. She is long term heavy smoker.
Many studies have shown that persistent smoking leads to Smoking has multiple negative impacts on aspects of
greater tooth loss and reduced response to periodontal immune functioning and inflammation, leading to increased
therapy. periodontal tissue destruction, and more limited outcomes
following periodontal treatment compared to non-smokers.(7).
Other risk factors were Given the harmful effects of smoking on the periodontal
tissues, we should feel confident in asking questions about
 Inadequate plaque control smoking status, and we can make things easier by using non-
 Poor compliance to dental treatment in the past threatening forms of words such as „I wouldn‟t be doing my
 Poor oral hygiene with improper technique of brushing job properly if I didn‟t ask you about whether you are still
Stress smoking(8). Informing patients of the consequences of
tobacco use is an ethical, medical and legal obligation. (9)
 High periodontal disease risk
The effect of plaque on the progression of periodontal
Therapeutic Goals
disease was explained. (10)The patient was shown pictures in
a flipchart of the effect of plaque accumulation on the
The primary goal is elimination of gingival inflammation
gingival tissues causing gingival inflammation
and correction of the conditions that cause and perpetuate it.
Stress: -Patient was explained about the consequences of
This includes not only elimination of root irritants but also
stress and how it effects the periodontal health. Stress level
pocket eradication and reduction, establishment of gingival
were discussed. Stress affects the immune system, which
contours and mucogingival relationships conductive to
fights against the bacteria that causes periodontal disease,
preservation of periodontal health, restoration of carious
making a person more prone to gum infection." Patients with
areas and correction of existing restorations. The goals of
inadequate stress behaviour strategies are at greater risk for
periodontal therapy are to alter or eliminate the microbial
severe periodontal disease (11) Stress is associated with poor
etiology and contributing risk factors for periodontitis,
oral hygiene, increased glucocorticoid secretion that can
thereby arresting the progression of disease and preserving
depress immune function, increased insulin resistance, and
the dentition in a state of health, comfort, and function with
potentially increased risk of periodontitis (12)
appropriate esthetics; and to prevent the recurrence of
periodontitis.
Patient Expectations and Assessment of Compliance
The patient‟s past poor compliance with dental treatment

was discussed. she accepted that a significant amount of
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Paper ID: SR20304125420 DOI: 10.21275/SR20304125420 276
ISSN: 2319-7064
destruction has been caused in the past, mainly through his  Bone replacement grafts;
own lack of motivation and now felt ready to address the  Guided tissue regeneration;
causes. Patient was advised success closely dependent upon  Combined regenerative techniques
compliance with Oral hygiene and enrolment on long‐term
maintenance program. Patient seemed to be motivated about Restorative Considerations
taking care of her oral hygiene and quit smoking.
In addition to the periodontal treatment, the restorative
The chronic nature of periodontal disease was discussed and considerations were discussed. The tooth surface loss due to
the patient understood the requirement for long term improper brushing as the patient reports vigorous brushing
compliance (oral hygiene/smoking) and maintenance
treatment/review for life. Was discussed and the reason for her sensitivity to cold and
hot. The option for composite restoration in 13 to 17, 23 to
Teeth with Poor Prognosis 27 was given.
The teeth with a poor prognosis were discussed i.e.: 17, Restoration with RPD/FPD:
16,43,12,11,21,31,32,33,34,41,42 These teeth were
identified in a mirror and using the patient‟s radiographs to In this case the anterior bone loss has been severe due to the
explain the reasons for their poor prognosis were outlined to periodontal disease and there is ridge defect, so a partial
the patient – namely the extent of the attachment loss RPD should be considered, since the FPD generally replaces
already, and the mobility The patient was warned that these only the missing tooth structure and not the supporting
areas may act as a reservoir for bacteria to reside – tissue.
potentially re- infecting other sites.
Treatment Plan
Treatment options
The following treatment plan was agreed:
After the diagnosis and prognosis was established, the
treatment was planned. The treatment plan was explained 1) Prevention
and discussed to the patient. It included all procedures  Individually tailored oral hygiene regime
required for the establishment and maintenance of oral  Smoking cessation:- motivation performed to get
health. The patient‟s treatment options were outlined, patient to stop smoking - Given oral hygiene
including a discussion on what the treatment would involve, instruction.
the risks/benefits, and long‐term success. 2) Non‐surgical Management
 Instruction, reinforcement, and evaluation of the
Option 1 patient‟s plaque control should be performed.
 Supra- and subgingival scaling and root planning
Do nothing should be performed to remove microbial plaque and
Explained that if periodontal disease is not addressed, there calculus.
is a high likelihood that it will progress further, resulting in
 Extaction of hopeless teeth.
further loss of attachment, mobility and ultimately tooth loss
3) Restorative treatment
Therefore this is not a viable option. Explaining that doing
 Composite restorations 13, 14,15,16,17, 23,
nothing or holding onto hopelessly diseased teeth as long as
24,25,26,27.
possible is inadvisable
 Treatment partial denture followed by cast partial
Option 2 denture 11,12,21,22,31,32,33,41,42,43,46
 Splinting16,17,26,27, 33,34,35,36,37,43,44,45,47
Cause‐related therapy. 4) Surgical phase Regenerative therapy:
 Flap surgery
Oral hygiene instruction to optimize patients own  Bone replacement grafts;
plaque control regime. Instruction, reinforcement, and  Guided tissue regeneration
evaluation of the patient‟s plaque control should be 5) Maintenance therapy
performed Proper tooth brushing technique i.e.: modified
bass technique 4. Sequence of Treatment
 Smoking cessation. Initial Inspection Appointment
 Non‐surgical Management – sub‐gingival scaling and root
surface instrumentation. At the inspection appointment, a full history, extra‐oral,
 Discussion about the extraction of hopeless teeth i.e.: 11, intra‐oral soft/hard tissue assessment and OPG was taken
12,21,22,31,32,41,42. Explained that due to extent of
attachment loss and mobility, the teeth has to be extracted. Further Diagnosis Appointment
Surgical phase Regenerative therapy At the further diagnosis appointment patient‟s periodontal
indices, including periodontal pocket depths, recession,
 Flap surgery bleeding and plaque scores were. An OPG was taken and it
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Paper ID: SR20304125420 DOI: 10.21275/SR20304125420 277
ISSN: 2319-7064
was at this appointment that a periodontal diagnosis was done under local anaesthetic (1.8ml articaine 4% with
made and the above discussions and treatment planning 1:200000 adrenaline. Debridement of cavity was done
options were discussed with the patient in detail. thoroughly. The socket was carefully examined for bony
fragments, pieces of roots into the socket. The diseased
 Instruction in oral hygiene were given and explained interradicular bone was removed to promote healing.
thoroughly. To create a “dynamic dialogue”, specific Gelatamp" colloidal silver gelatine sponge was implanted
skills in communication were required and therefore into the socket. The bucal and lingual plates were firmly
methods of MI were included. MI is characterized by pressed between thumb and index finger. The wound was
reflective listening and is used in an attempt to covered with gauze as a pressure pack for obtaining a good
understand the meaning of statements. Initiation and clot. Patient was given post extraction instructions. Patient
analysis of knowledge, expectations, and motivation was not willing for pictures after extraction.
 Initially, an interview with open-ended questions  Temporary prosthetic replacements with removable
ascertained the patient's knowledge of periodontal immediate denture.
disease, self-care habits, and attitude towards oral
hygiene, as well as outcome expectations and Re-evaluation
experiences from earlier treatment
 Disclosing solution was used to illustrate any current oral The patient is due to attend her first post‐treatment review.
biofilm and to initiate a discussion related to oral hygiene At this appointment a full periodontal charting will be
aids that might support the patient's oral health goal. The completed to assess the healed areas and persistent areas of
patient's motivation to use various oral hygiene aids was disease. A bleeding index will be taken to assess absence of
explored bleeding (a strong indicator of absence of disease) and a
 Instruction sessions on “what to do” and “how to do it” plaque index will be taken to ensure OH compliance is
were performed by the wash basin in front of a mirror to maintained.
make the circumstances as near to a home routine as
possible Additional (corrective) therapy
 The choice of toothbrush and toothpaste can be enormous
factors in influencing a patient‟s oral health. Choosing  Extraction of the teeth that have poor prognosis
the right toothbrush and toothpaste can help halt tooth  Periodontal surgery
wear and symptoms for the patients.  Regenerative therapy:
 Advice to stop using abrasive tooth brushes and  Flap surgery
whitening paste Advise on brushing teeth gently and  Bone replacement grafts
avoid sawing motion. Recommending the use of brushes  Guided tissue regeneration;
with small heads and soft bristles & explaining her  Combined regenerative techniques
modified bass technique and that too not more than 2
minutes. Using of floss & interdental brushes. Supportive (or maintenance) therapy
 At the end of session, the patient's self-efficacy and
readiness to change an oral hygiene habit was explored  A detailed history in particular with regards to established
through a direct question. Subsequently, the oral hygiene risk factors for periodontitis and possibilities for
procedures, how, when, and where to use the desired oral controlling them
hygiene aid or aids, and which area should be given  A thorough periodontal examination including assessment
particular attention to until the next session were of oral hygiene,
discussed and agreed upon. The action plan for oral self-  Re-motivation and re-instruction when necessary
care to the next session was formulated in writing.  Supragingival scaling and polishing; subgingival scaling
Patients were encouraged to start using the oral hygiene under local anesthesia in areas with persistent pockets (5
aid they deemed to have the best chance of being mm or more) which have bled upon probing
successful in reaching the intermediate goal. 
 The patient was informed that relapses are common The suggested recall interval mainly depend on the overall
during behavioural change Strategies for maintaining risk, in this case patients having a high risks will be seen
already achieved goals for oral hygiene were discussed. after 3 months. In a few cases, patients may continue to
Specific risk situations for inter-dental cleaning relapse present with periodontal problems in spite of practicing good
were identified and problem-solving strategies oral hygiene and without any obvious local causes. In such
werediscussed. The discussions focused on situations in cases, bacteriological sampling from involved sites,
which oral hygiene was facilitated and how to find identification of possible 26 pathogens and antibiotic
solutions to the problems the patient encountered therapy may be indicated.
 Scaling and root surface debridement was done. Non- 
surgical root surface debridement was integrated during The importance of periodontal maintenance care is clear
the initial dental hygiene treatment mainly performed from studies which show that patients who receive
with combination with hand instruments LM® Gracys appropriate maintenance lose very few teeth (13)
curette and ultrasonic.
Extraction of hopeless teeth was also done in this phase.

Extraction of the teeth 31, 32, 41 and 42. The treatment was

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Paper ID: SR20304125420 DOI: 10.21275/SR20304125420 278
ISSN: 2319-7064
Prognosis [2] Caffesse RG, Mota LF, Morrison EC. The rationale for
periodontal therapy. Periodontology 2000. 1995 Oct;
The long term success of the treatment of the complex cases 9(1):7-13. [CrossRef]
with severe chronic periodontitis depends significantly upon [3] Mohan CS, Harinath P, Cholan PK, Kumar DL.
the proper control of the periodontal infection and the Predictable aesthetic outcome with immediate placement
achieving of a stable periodontal status. These are the major and early loading of one piece mini implant - A 5 year
prerequisites for successful further implant and prosthetic follow-up case report. J Int Oral Health. 2014
rehabilitation(14). In this patient with more severe disease, as Apr;6(2):132– 135.[PubMed]
[4] Cosyn J, Eghbali A, Hanselaer L, De Rouck T, Wyn I,
evidenced by furcation involvements and increasing
Sabzevar MM et al. Four modalities of single implant
mobility or if the patient is noncompliant with oral hygiene
treatment in the anterior maxilla: A clinical, radiographic,
practices, the prognosis is poor. Studies on the survival and aesthetic +evaluation. Clin Implant Dent Relat Res.
characteristics of periodontally involved teeth have indicated 2013 Aug; 15(4):517- 30. [PubMed]
that the combination of severe alveolar bone destruction and [5] TURANI, D., BISSETT, S. M. & PRESHAW, P. M.
increased mobility in teeth with furcation disease is 2013. Techniques for effective management of
associated with a poor prognosis(15,16,17) periodontitis. Dental update, 40, 181-4, 187-90, 193.
[6] TURANI, D., BISSETT, S. M. & PRESHAW, P. M.
5. Summary 2013. Techniques for effective management of
periodontitis. Dental update, 40, 181-4, 187-90, 193.
A 55 year old woman was diagnosed with chronic [7] Heasman L, Stacey F, Preshaw PM, McCracken GI,
generalized severe periodontitis with bone destruction and Hepburn S, Heasman PA. The effect of smoking on
mobility. Mobility was seen in almost all the teeth. Studies periodontal treatment response: a review of clinical
suggest that tooth mobility may be associated with adverse evidence. J Clin Periodontol 2006; 33: 241−253
effects on the periodontium and affect the response to [8] TURANI, D., BISSETT, S. M. & PRESHAW, P. M.
2013. Techniques for effective management of
therapy with respect to gaining clinical attachment. (18,19)
periodontitis. Dental update, 40, 181-4, 187-90, 193.
With regards to treatment, occlusal therapy aids in reducing
[9] Ramseier CA, Warnakulasuriya S, Needleman IG et al.
tooth mobility and gaining some bone lost due to traumatic Consensus Report: 2nd European Workshop on Tobacco
occlusal forces. Once periodontal health is established, Use Prevention and Cessation for Oral Health
occlusal therapy can be used to reduce mobility, to regain Professionals. Int Dent J 2010; 60: 3−6
bone lost owing to traumatic occlusal forces, and to treat a [10] Ower P. The role of self‐administered plaque control in
variety of clinical problems related to occlusal instability the management of periodontal disease: 1. A review of
and restorative needs. (20) So splinting was suggested in this the evidence. Dent Update 2003; 30: 60‐8.
case to reduce mobility and regain bone loss. [11] M. Aimetti, F. Romano, and F. Nessi, “Microbiologie
analysis of periodontal pockets and carotid atheromatous
During her appointment, oral hygiene instruction, smoking plaques in advanced chronic periodontitis patients,”
cessation advice, and non‐surgical management Journal of Periodontology, vol. 78, no. 9, pp. 1718–1723,
(sub‐gingival scaling and RSI) were completed. At her 2nd 2007
visit the patient‟s motivation has been deemed to be good [12] A. T. Merchant, W. Pitiphat, B. Ahmed, I. Kawachi,
and the patient has reported her smoking cessation attempt is and K. Joshipura, “A prospective study of social
going well so far. support, anger expression and risk of periodontitis in
men,” Journal of the American Dental Association, vol.
Over the long‐term, if compliance is poor, there is a high 134, no. 12, pp. 1591–1596, 2003
[13] Fardal O, Johannessen AC, Linden GJ. Tooth loss during
risk of disease progression and the prognosis for the
maintenance following periodontal treatment in a
dentition is guarded, particularly for 15, 13, 22, 23, 26, 27,
periodontal practice in Norway. J Clin Periodontol 2004;
35, 36, 47 and poor for 17, 16, 43, 12, 11, 21, 31, 32, 33, 34, 31: 550−555
41, 42. In this scenario it is likely the patient will require [14] Kamen Kotsilkov1, Radoi Dimitrov COMPLEX
extraction of the worst affected teeth and palliative TREATMENT IN A PATIENT WITH SEVERE
periodontal treatment to attempt to slow the progression of CHRONIC PERIODONTITIS (Case Report) Journal of
disease. If the patient‟s compliance with Oral hygiene, IMAB -Annual Proceeding (Scientific Papers) 2015, vol.
smoking cessation and attendance for review can be 21, issue 1
maintained and with non-surgical and surgical management [15] Hirschfeld L, Wasserman B. A long term survey of tooth
then the long‐term prognosis for the majority of the dentition loss in 600 treated periodontal patients. J Periodontol
is fair.. Her home care is key to the maintenance of health 1978; 49: 225−23
and this has been emphasised to the patient. In this case [16] Chace R Sr, Low SB. Survival characteristics of
apart from non-surgical approach, a surgical approach is periodontally involved teeth. A 40 year study. J
necessary for the treatment plan for regenerating the lost Periodontol 1993; 64: 701−705
periodontal tissues as there is advanced attachment loss. [17] McGuire MK, Nunn ME. Prognosis versus actual
outcome III. The effectiveness of clinical parameters in
accurately predicting tooth survival. J Periodontol 1996;
References 67:666−674.
[18] Lindhe J, Ericsson I. The effect of elimination of jiggling
[1] Teles R, Teles F, Frias-Lopez J, Paster B, Haffajee A. forces on periodontally exposed teeth in the dog. J
Lessons learned and unlearned in periodontal Periodontol 1982;53:562-7.
microbiology. Periodontology 2000. 2013 Jun;62(1):95-
162. [PubMed] [CrossRef]
www.ijsr.net
Paper ID: SR20304125420 DOI: 10.21275/SR20304125420 279
ISSN: 2319-7064
[19] Neiderud A-M, Ericsson I, Lindhe J. Probing pocket
depth at mobile and nonmobile teeth. J Clin Periodontol
1992;19:754-9
[20] Gher ME.. Changing concepts. The effects of occlusion
on periodontitis.Dent Clin North Am. 1998
Apr;42(2):285-99. Review

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Comprehensive Assessment Diagnosis and Treatment Planning of Severe Periodontal Disease

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International Journal of Science and Research (IJSR)

Comprehensive Assessment, Diagnosis and

Volume 9 Issue 3, March 2020

Volume 9 Issue 3, March 2020

 Pockets of 6mm and over in most of the teeth

Abrasion: biomechanical frictional processes.

These lesions are provoked by tooth brushing.

Right Buccal view

Anterior View teeth in occlusion

Left buccal view

Anterior View teeth apart

Maxillary occlusal view

Volume 9 Issue 3, March 2020

31:- No existing restoration and no caries detected 80%

Volume 9 Issue 3, March 2020

The patient‟s past poor compliance with dental treatment

Extraction of hopeless teeth was also done in this phase.

Volume 9 Issue 3, March 2020

Volume 9 Issue 3, March 2020

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